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1.
Dig Dis ; 25(2): 160-5, 2007.
Article in English | MEDLINE | ID: mdl-17468552

ABSTRACT

BACKGROUND: Intestinal complaints are a frequent health concern for elderly people and their care providers. AIMS: To explore the distinction between constipation and the subjective complaints in elderly people and to review the diagnosis, causes and treatment of constipation, fecal impaction, and fecal incontinence. METHODS: Review of studies that give information on prevalence, causes, symptoms, and treatment of bowel problems in the elderly, excluding uncontrolled clinical observations. RESULTS: Self-reported constipation and laxative use increase with age and are more common among women, blacks and people of low socio-economic level. The patient's pharmacological history is fundamental, because medications are the cause of up to 40% of chronic constipation, and are often used inappropriately. The results of most laxative trials require cautious interpretation, but fiber and laxatives are more effective than placebo against constipation. Much additional research is needed to determine the most cost-effective method of treating intestinal complaints in the elderly. CONCLUSIONS: Bowel problems in older people have a considerable impact on the quality of life and have many contributory causes that are often amenable to treatment and management. Results of therapy can be good, leading to alleviation of suffering and the ability to lead a fuller life.


Subject(s)
Aging/physiology , Constipation/epidemiology , Constipation/therapy , Fecal Impaction/therapy , Aged , Aged, 80 and over , Cathartics/therapeutic use , Colon/physiopathology , Constipation/diagnosis , Diet , Exercise , Fecal Impaction/diagnosis , Fecal Impaction/epidemiology , Female , Fluid Therapy , Humans , Male , Prognosis , Risk Assessment
2.
Aliment Pharmacol Ther ; 14(3): 325-30, 2000 Mar.
Article in English | MEDLINE | ID: mdl-10735926

ABSTRACT

AIM: To investigate the efficacy of a 1-week triple therapy with amoxycillin, clarithromycin, and omeprazole or ranitidine bismuth citrate (RBC) in curing Helicobacter pylori infection and healing duodenal ulcers. METHODS: One hundred and ninety-two consecutive out-patients with duodenal ulcer, in whom H. pylori infection was confirmed by histology and a urease biopsy test, were randomly assigned to a 1-week treatment with either 400 mg b.d. ranitidine bismuth citrate (RAC group) or 20 mg omeprazole b.d. (OAC group) in combination with 1 g amoxycillin b.d. and 500 mg clarithromycin b.d. RESULTS: Eradication of H. pylori was successful in 77% (per protocol) and 61% (intention-to-treat) of the patients in the RAC group and in 79% (per protocol) and 70% (intention-to-treat) of those in the OAC group. The difference was not significant. Per protocol analysis showed ulcers were healed in 97% of patients in the RAC group and 96% in the OAC group. Adverse effects were seen in four patients in each group: they caused discontinuation of the therapy in one patient of the OAC group. CONCLUSIONS: Eradication rates obtained in this study were lower than those expected on the basis of previously reported studies. The two 1-week treatment regimens were equally effective in healing H. pylori associated duodenal ulcer disease.


Subject(s)
Anti-Bacterial Agents/therapeutic use , Anti-Ulcer Agents/therapeutic use , Bismuth/therapeutic use , Duodenal Ulcer/drug therapy , Helicobacter Infections/drug therapy , Helicobacter pylori , Ranitidine/analogs & derivatives , Ranitidine/therapeutic use , Adolescent , Adult , Aged , Aged, 80 and over , Amoxicillin/therapeutic use , Clarithromycin/therapeutic use , Duodenal Ulcer/microbiology , Female , Helicobacter Infections/microbiology , Humans , Male , Middle Aged , Omeprazole/therapeutic use , Patient Compliance , Penicillins/therapeutic use , Prospective Studies , Single-Blind Method
3.
Aliment Pharmacol Ther ; 12(5): 433-8, 1998 May.
Article in English | MEDLINE | ID: mdl-9663722

ABSTRACT

BACKGROUND: Effective anti-Helicobacter pylori therapies with few side-effects are needed. AIM: To study the effectiveness of short-term triple therapy with amoxycillin, clarithromycin and either omeprazole or lansoprazole for eradication and healing of peptic ulcers. METHODS: Patients with gastric or duodenal ulcers received amoxycillin (1 g b.d.), clarithromycin (500 mg b.d.) and lansoprazole (30 mg b.d.) (LAC) or omeprazole (20 mg b.d.) (OAC) for 7 days. Endoscopic examinations were performed before treatment and at least 4 weeks after completion of therapy. H. pylori status was confirmed by rapid urease test and histological examination (Giemsa stain) from gastric biopsies taken from both the antrum and the body. RESULTS: A total of 356 patients were randomized in this single-blind study. On a per protocol basis, H. pylori was eradicated in 134 of 170 patients (79%) in the lansoprazole group and in 105 of 146 (72%) in the omeprazole group (P = 0.189); and in intention-to-treat analysis 72% and 62%, respectively (P = 0.043). Healing of the ulcers was obtained in 166 of 186 (98%), and in 139 of 146 patients (95%), respectively (P = 0.357). Side-effects occurred in two patients in the LAC group and in six in the OAC group B (four stopped therapy). CONCLUSIONS: This study has shown that the two regimens are highly effective in healing duodenal ulcers and are well tolerated. Neither treatment achieves the ideal cure rate for H. pylori. Lansoprazole does not appear to have a significant advantage over omeprazole either in ulcer healing or in H. pylori eradication.


Subject(s)
Anti-Ulcer Agents/therapeutic use , Helicobacter Infections/drug therapy , Helicobacter pylori , Omeprazole/analogs & derivatives , 2-Pyridinylmethylsulfinylbenzimidazoles , Adult , Aged , Aged, 80 and over , Amoxicillin/adverse effects , Amoxicillin/therapeutic use , Anti-Bacterial Agents/adverse effects , Anti-Bacterial Agents/therapeutic use , Anti-Ulcer Agents/adverse effects , Clarithromycin/adverse effects , Clarithromycin/therapeutic use , Female , Gastric Mucosa/pathology , Helicobacter Infections/pathology , Humans , Lansoprazole , Male , Middle Aged , Omeprazole/adverse effects , Omeprazole/therapeutic use , Penicillins/adverse effects , Penicillins/therapeutic use , Prospective Studies , Stomach Ulcer/drug therapy , Stomach Ulcer/pathology
4.
Ital J Gastroenterol Hepatol ; 30(2): 199-201, 1998 Apr.
Article in English | MEDLINE | ID: mdl-9675659

ABSTRACT

A new case of congenital short pancreas (partial agenesis or hypoplasia of the dorsal pancreas) is reported. The patient was a 61-year-old caucasian man, referred for two episodes of non-severe acute biliary pancreatitis. Clinical and laboratory findings and the presence of ultrasound biliary sludge in the gallbladder supported the biliary origin of pancreatitis. Computerized tomography revealed a slightly enlarged and hypodense head of the gland but could not identify any pancreatic tissue in the region of the body and tail. Endoscopic retrograde pancreatography showed a short pancreas with a duct system in communication both with the accessory and main papilla. Laparoscopic cholecystectomy was performed and no further episodes of abdominal pain occurred. Short pancreas is a rare congenital abnormality consisting in the parenchyma and ductal system restricted to the head with some residual dorsal tapering and arborizing ducts communicating with the minor papilla. This anomaly can be an incidental finding and its association with episodes of recurrent pancreatitis needs to be proven.


Subject(s)
Cholecystectomy, Laparoscopic , Pancreas/abnormalities , Pancreatitis/etiology , Pancreatitis/surgery , Acute Disease , Biliary Tract Diseases/diagnosis , Biliary Tract Diseases/surgery , Cholangiopancreatography, Endoscopic Retrograde , Disease-Free Survival , Humans , Male , Middle Aged , Pancreatitis/diagnosis , Recurrence
5.
J Clin Gastroenterol ; 13(5): 546-8, 1991 Oct.
Article in English | MEDLINE | ID: mdl-1744391

ABSTRACT

We studied the time of onset and other clinical features of biliary pain in 54 patients living in Northern Italy. All patients had cholelithiasis documented by ultrasonography. The time of onset of pain followed a circadian periodicity with its peak occurring at 9:30 p.m. The typical biliary pain was steady, mostly localized in the right upper quadrant of the abdomen or the epigastrium, lasted over 1 h, and required analgesics for relief. The pain was not related to meals or body position. What precipitates biliary pain is still an enigma.


Subject(s)
Cholelithiasis/physiopathology , Circadian Rhythm/physiology , Colic/physiopathology , Female , Food , Humans , Male , Middle Aged , Posture
6.
Gastrointest Endosc ; 28(3): 173-5, 1982 Aug.
Article in English | MEDLINE | ID: mdl-6215281

ABSTRACT

A prospective and controlled trial in 92 patients was done to determine the influence on the onset of pain during laparoscopy under local anesthesia by age, sex, perlaparoscopic guided liver biopsy, the presence of adhesions and of ascites, and the type of gas (CO2 or N2O) used in the abdominal cavity. N2O was found less pain provoking, while other factors had no influence on the onset of pain.


Subject(s)
Carbon Dioxide/administration & dosage , Laparoscopy/methods , Nitrous Oxide/administration & dosage , Pain/prevention & control , Adult , Age Factors , Aged , Ascites/complications , Clinical Trials as Topic , Double-Blind Method , Female , Humans , Laparoscopes , Male , Middle Aged , Sex Factors
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